The influence between perioperative nutritional support and outcome of refractory constipation patients complicated with megacolon / 中国医师进修杂志

ABSTRACT

Objective To explore the influence between perioperative nutritional support and outcome of refractory constipation patients complicated with megacolon.Methods Seventy-three patients with refractory constipation complicated with megacolon receiving surgical interventions were enrolled,both by gastrointestinal decompression and total parenteral nutrition support treatment.Thirty-seven cases who could not recover intestinal tract unobstructed,did not receive enteral nutrition support treatment and surgery as control group; 36 cases of patients with intestinal recovery unobstructed,after 2 weeks of total enteral nutrition support undergoing elective surgery as observation group.The nutrition indicators,surgery and postoperative complications between two groups were compared.Results The operation time and intraoperative blood loss compared between two groups had no significant difference (P ＞0.05).The operation method between two groups was statistically significants (P ＜ 0.05).The incidence of anastomotic bleeding,anastomotic fistula and pneumonia in observation group were lower than those in control group [2.8％ (1/36) vs.21.6％ (8/37),0 vs.13.5％ (5/37) and 0 vs.13.5％ (5/37)],there were significant differences (P ＜ 0.05).The hospitalization time,incidence of incision infection,urinary retention,intestinal obstruction between two groups had no significant difference (P ＞ 0.05).The postoperative hospital stay in observation group was shorter than that in control group [(12 ± 3) d vs.(25 ± 6) d],there was significant difference (P ＜ 0.05).The index comparison on admission similar between two groups had no statistical significance (P ＞0.05).The preoperative fat weight,fat mass and serum albumin,transferrin and prealbumin in observation group were higher than those in control group [(41.9 ± 7.6) kg vs.(38.7 ± 3.0) kg,(13.2 ± 4.0) kg vs.(7.8 ± 2.7) kg,(37.9 ± 2.6) g/L vs.(31.3 ± 2.5) g/L,(2.9 ± 0.6) μ g/L vs.(2.0 ± 0.6) μ g/L,(243.7 ± 25.2) mg/L vs.(141.2 ± 11.9) mg/L],there were significant differences (P ＜ 0.05).After 1 month,the weight,fat weight,protein quality,fluid in cells and extracellular fluid,body mass index,albumin,transferrin in observation group were better than those in control group [(55.1 ± 6.4) kg vs.(50.9±4.7) kg,(42.9 ± 3.2) kgvs.(39.1 ± 1.3) kg,(12.2 ± 1.4) kg vs.(9.7 ± 3.2) kg,(23.7 ± 5.0) Lvs.(18.8 ± 5.5) L,(10.9 ± 4.5) L vs.(7.7 ± 0.8) L,(22.3 ± 1.9) kg/m2 vs.(17.5 ± 3.6) kg/m2,(41.9 ± 4.7) g/L vs.(33.1 ± 2.9) g/L and (3.5 ± 0.7) μg/L vs.(2.7 ± 0.5) μg/L],there were significant differences (P ＜0.05).Conclusion Refractory constipation complicated with megacolon requires surgical intervention,should as far as possible to restore the intestinal function preoperatively,enteral nutrition support treatment,can significantly reduce the incidence of perioperative complications.